From the President’s Desk: Look to pathways for opportunities

Create PDF

Stanley J. Robboy, MD

March 2013—Regular readers know that the CAP has spent the past several years exploring how we can ensure a bright future for pathology. The future, of course, as my adult children would quip, is “ours, but also ours to lose.”

As we embrace new tools that enable us to decipher the molecular code of life, unravel the essential causes of disease, and develop miraculous new therapies, payment models are also evolving in fundamental ways. It appears likely that fee-for-service will be replaced by schemes that more directly measure value in terms of improved outcomes and cost efficiency.

Some 70 CAP members developed the data that built our Case for Change. With that in hand, we commissioned G2 Intelligence to help us formulate practical new ways to secure our economic future. “Promising Practice Pathways,” an astute, arms-length view of our opportunities and challenges, is the product. Written by pathologist Eleanor J. Herriman, MD, MBA, who heads the company’s advisory services, the pathways document is available for download at yourpathyourchoice.org.

“Promising Practice Pathways” offers concrete advice for pathologists who are coming to grips with the uncertainties of an evolving health care environment. It sets out fundamental considerations, which include urgency, risk, and reward. The four pathways that have been developed focus on new and more extensive services in oncology, diagnostic services, coordinated population care settings such as ACOs, and ambulatory patient diagnostic service centers.

To my mind, fee-for-service has become unsustainable, if only because it is about thinking small. How did we come to a system where compensation is based on test volume? It’s not surprising that the public discourse about health care is now so often focused on shrinking resources and competing needs.

Health care payment is moving to a value-based model designed to reward care that improves quality and lowers costs. Those who step up and embrace risk will find themselves working more closely with other clinicians, administrators, and possibly policymakers, tweaking measures to improve population-based care, creating evidence-based treatment schemes, and putting an end to the perception that our expertise is limited to tissue analysis and test management. The vocabulary may have changed, but fundamentally this is a return to our roots.

Pathologists are uniquely positioned to provide knowledge services that will enable optimal patient care outcomes and improved efficiencies. We need to get the word out on that point, which calls for initiative, energy, and healthy risk-taking.